Annals of Occupational and Environmental Medicine

Original article

Acute health effects of accidental exposure to lithium hydroxide at a battery material production plant: Chul Gab Lee, Su Young Park, Ji Won Kang, Si Woo Hwang, Hyeo Na Kim, Hyeon Kyeong Ko; Ann Occup Environ Med 2026;e6. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e6 [Accepted]

Abstract PDF: Background
Lithium hydroxide (LiOH) is increasingly used in electric vehicle battery production; however, its health effects in the work environment remain underreported. This study characterizes the acute health effects on workers following accidental occupational exposure to LiOH at a South Korean lithium plant in March 2024.
Methods
We analyzed health effects from two LiOH exposure accidents on March 6 and 9, 2024, involving 50–100 kg powder spills. Two datasets were examined: acute symptoms from 115 workers who visited hospitals immediately after exposure, and a symptom severity survey from 474 workers conducted 2 weeks post-exposure. Workers were stratified by distance from the leak source (<10 m, 10–20 m, >20 m) and respirator use. Univariate general linear modeling was applied to analyze the relationship between symptom occurrence and both the distance from the exposure source and respirator use.
Results
Among workers visiting hospitals immediately, local irritation symptoms predominated: sore throat (58.3%), cough (28.7%), and skin dermatoses (17.4%). Systemic symptoms included headache (45.2%), nausea (18.3%), chest tightness (12.2%), and dizziness (9.6%). Two-week follow-up revealed overall symptom improvement; severe cough decreased from 22.2% to 10.1%. However, despite general improvement, a significant portion of workers reported persistent respiratory issues, including cough (28.7%) and sputum production (31.0%). Symptom severity showed a significant dose-response relationship with proximity to the source (p < 0.001). While respirator use offered initial protection (p = 0.021), this effect was not statistically significant after 2 weeks.
Conclusions
Occupational LiOH exposure caused acute irritation and systemic symptoms, demonstrating immediate tissue damage consistent with its alkalinity and systemic toxicity upon absorption. As lithium battery production expands globally, these results emphasize the necessity for developing specific occupational exposure limits and medical surveillance guidelines for lithium compounds.

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Case Report

Case series: from ventilation failure to substitution success—a hierarchy of controls analysis of lead poisoning at a Korean indoor firing range: Chul Gab Lee, Su Young Park; Ann Occup Environ Med 2026;e5. Published online February 9, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e5 [Accepted]

Abstract PDF: Background
Indoor firing ranges are globally recognized as high-risk settings for occupational and recreational lead exposure due to the use of lead-based ammunition and frequently inadequate ventilation systems. In Korea, however, public health surveillance and regulatory oversight have remained limited. This case series empirically demonstrates that in high-emission settings like indoor firing ranges, ventilation upgrades are insufficient. Source substitution with lead-free primer ammunition proved to be the only definitive intervention.
Case Presentation
In late 2023, an index case presenting with abdominal pain was found to have a blood lead level (BLL) of 55 µg/dL, prompting a government-mandated investigation. Nine male shooting instructors (tenure: 4–65 months) were subsequently identified with BLLs ranging from 38.2–73.2 µg/dL, while airborne lead concentrations (ALC) reached 0.51 mg/m³—10 times the occupational exposure limit (OEL: 0.05 mg/m³). During a three-month closure to upgrade ventilation, workers received chelation therapy (CaNa₂EDTA and D-penicillamine), which reduced their BLLs to 3.2–25.7 µg/dL. However, two months after reopening, post-intervention ALC remained elevated at 0.0797 mg/m³, still exceeding the OEL, and BLLs rebounded to 16.2–53.3 µg/dL. A substitution strategy was then implemented, replacing lead-based ammunition with copper-clad, lead-free primer rounds. This intervention decreased ALC to <0.003 mg/m³ and lowered BLLs to 4.9–23.1 µg/dL. Despite the reduced airborne concentrations, several workers continued to exhibit BLLs around 20 µg/dL, suggesting subtle ongoing exposure and mobilization of bone-stored lead.
Conclusions
This cluster demonstrates that in environments where hazardous agents are continuously generated, such as indoor firing ranges, engineering controls alone, such as improved ventilation, may not provide adequate protection. Substitution—the most effective intervention within the hierarchy of controls—was essential for eliminating exposure. Furthermore, the toxicokinetics of bone lead in chronically exposed adults highlight the need for ongoing monitoring and cautious decision-making regarding treatment and return-to-work planning.

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